9908-070 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License Lic. Class �l y,Exp. Date
r7
Dto Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). '
() I am exempt under Section B&P.C. for this reason
Date Signature'of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty, of perjury one of the following declarations:
() I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor'Code, for: the
performance of the work for which this permit is.issued..
(A)e I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier •& policy no. are:
Carrier -Policy No. ;
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(This section need not be completed if the permit:valuation is for $100.00 or less).
() I certify that in the performance of the -work for which this permit is, issued,
I shall not employ any pers.on.in any manner so as to become subject to the
workers' compensation laws of California, ayd-agree that if,l should become
subject �l5/thenworkers' compensationprovlslons Qf Sectiori 3700 of the Labor
Code I'shall fWrRwith'comply with_thiose provistions.
LI date: Applicant
Warning: Failure to secure Workers' Compensation coverage.is unlawful and
shall subject an employer to criminal penalties'and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director -of Building and Safety
for a permit subject to the conditions and restrictions set. forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued, as a result of this applicaton agrees -to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating.to the building
construction, and hereby authorizerepresentatives of this City16 entgf upon
thee above-mentioned propdrty fort inspec!tl'on purposes.- <•%/'��
Signature (Owner/Agent) Date
BUILDING PERMITPERMIT#
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ADDRESS %c '�.ti.! (1,60.1) VIEW WAY JOB SITE
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OWNER
CONTRACTOR/DESIGNER/ENGINEER
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\C'34471`9
RECEIPT
DATE
BY
f
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE ,
INSPECTOR
OPERATION
DATE'
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade /
Return Air
Steel
Combustion.Air
Roof Deck
Exhaust Fans
O.K. to Wrap S T'
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L. „i:
Grills
Fireplace T.O. -
Fans & Controls
Party.Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath -
Drywall - Int. Lath o -2.6 -
Final
Final ryPOOLS
- SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final.
Water Piping
Plumbing Final,
Plumbing Top'Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection - l — 4
Encapsulation
Gas Piping
Gas Test y >? q S
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) r( 7
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) / L Q
IIt
Certificate of Occupancy
City of La Quinta.
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 78-255 CLOUD VIEW WAY
Use Classification: SFD Bldg. Permit No.: 9908-070.
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: WORLD DEVELOPMENT, INC. Address: 78-120 CALLE ESTADO #104
Building Official
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 12-8-99
POST IN A CONSPICUOUS PLACE
DEC -08-1999 11!26 WESTERN INSULATION 909 686 8786 P.06i10
f
WED13 I ERN iNSULATION, INC.
4211 Lathan► Street, Riverside, California 9wol
' 19091686.8760
01686-8786 Fox
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: SEASON VILLA -PHASE III TRACT #:28019
LOT#: r"'%57 � .
SITE ADDRESS: 78=255jCLOUD VIEW WAY, LA QUINTA,.CA:=
0
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8
CEILINGS: BATT BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: '13"
CEILINGS: BATTS LQ
MANUFACTURER. GREENSTONE THICKNESS: 10.3"
GENERA L. CONTRACTOR:
LICENSE NUMBER:
BY:
TITLE: S �, e_r
DATE.• /2'B'• ?2
WORLD DEVELOPMENT
R -VALUE: R-13
R -VALUE: R-38
R -VALUE: R-38
INSULATION CONTRACTOR: WESTERN INSULATION, INC,
LICENSE NUMBER: 481278
BY:
TITLE: rodu n Manager
DATE: DECEMBER 8, 1999